Provider Demographics
NPI:1033200332
Name:ADVANCED IMAGING CENTER OF LEESBURG LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING CENTER OF LEESBURG LLC
Other - Org Name:ADVANCED IMAGING CENTER AT THE VILLAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-435-0111
Mailing Address - Street 1:13940 HIGHWAY 441
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8908
Mailing Address - Country:US
Mailing Address - Phone:352-750-1551
Mailing Address - Fax:352-205-1551
Practice Address - Street 1:13940 HIGHWAY 441
Practice Address - Street 2:SUITE 201
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8908
Practice Address - Country:US
Practice Address - Phone:352-750-1551
Practice Address - Fax:352-205-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4542AMedicare ID - Type UnspecifiedMEDICARE PROVIDER